Additional Covid-19 Anticoagulation Recommendations:

Should biomarkers, such as D-dimer, be used to change anticoagulation management (ie intensification of anticoagulation)?

While elevations of D-dimer and other biomarkers have been associated with worse outcomes in patients with Covid-19 (1-3), it is unknown if intensification of anticoagulant therapy based biomarker thresholds alone improves patient outcomes. Based on currently available evidence, societal guidance (AC forum, ISTH, ASH) does not recommend using biomarkers, such as D-dimer, for intensification of anticoagulation dosing. However, acutely worsening clinical status (including persistent clotting of lines) in conjunction with laboratory value changes, such as a rising d-dimer, may necessitate further thromboembolic workup or empiric treatment.

1. Tang N, Li D, Wang X, Sun Z. Abnormal coagulation parameters are associated with poor prognosis in patients with novel coronavirus pneumonia. JTH 2020

2. Tang N, Bai H, Chen X, Gong J, Li D, Sun Z Anticoagulant treatment is associated with decreased mortality in severe coronavirus disease 2019 patients with coagulopathy. J Thromb Haemost 2020

3. Zhou F, Yu T, Du R, Fan G, Liu Y, Liu Z, et al. Clinical course and risk factors for mortality of adult inpatients with COVID-19 in Wuhan, China: a retrospective cohort study. The Lancet 2020

Article from the Journal of Thrombosis and Thrombolysis:

Thromboembolism and Anticoagulant Therapy During the COVID-19 Pandemic: Interim Clinical Guidance from the Anticoagulation Forum

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